Coronavirus has blown open many of the issues contemporary society faces as a whole.
The UK Government has acted radically in the last few weeks. The furlough scheme has guaranteed many workers pay, and a huge effort has provided support for charities and businesses. Yet many have been left behind.
Those laid off have joined record applicants for unemployment benefit, as we look on from the precipice of the worst economic crash since the 1930s. Key workers have emerged as national heroes, but their low-pay has highlighted imbalances in our societal values. High earners continue to work from the safety of their homes, and companies are still paying shareholders, whilst relying on government bailouts to pay their staff. It is clear the government has not acted radically enough.
Yet Britain has an established history of putting radical thoughts into practice.
In 1941, the wartime coalition government began to envision how British society should look after the war. The “homes for heroes” scheme had rewarded soldiers’ service in the First World War with proper housing, and it was felt a similar repayment for sacrifices in this conflict was due. By 1942, three long years before the war would end, the report was finished. Inside was the blueprint for the modern welfare state, which aimed to pool the resources of every working citizen to maintain a standard of living “below which no one should be allowed to fall”.
George Orwell commented at the time that “it is something of an achievement even to be debating such a thing in the middle of a desperate war in which we are still fighting for survival”. It would take 6 years until the crowning glory of these reforms was unveiled with the official opening of New Park Hospital in Manchester, the first NHS hospital. Offering free healthcare to all at the point of use, the NHS remains unique around the world.
Now, in the midst of catastrophe, it is again time to explore bold new ideas.
The coronavirus has transformed our lives beyond recognition, and whilst the number of deaths seem to be flattening, it is clear we will remain in the grips of this crisis for the foreseeable future. It is also clear we cannot continue life as we have.
Our political response must adapt accordingly. Ideas like Universal Basic Income or negative income taxes may help guide us through the economic challenges of coronavirus, but more radical thought will be needed in the coming crises of climate change, creeping automation, and digital insecurity. Political thought must again create mainstream policies from the far margins of political thought.
Many ideas previously dismissed as too radical, or too costly, will become reality as society realigns its values in the face of crises. The NHS was initially rejected by Britain’s largest doctors union, the BMA, who claimed it was a threat to doctors’ livelihoods. 72 years later, we step out every Thursday evening to applaud their work.
Britain has adapted before, Now we must do it again.
* Tom Badham worked with the Cheltenham Liberal Democrat party during the last election, and has an MA in Political Communications.
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21 Comments
So yes, some of us are on some sort of semi-holiday, albeit at home, but still being paid, others have lost work and aren’t paid, others still are being overworked, in risky situations, and perhaps paying a lot extra for childcare. Economically, this is affecting different people very differently.
Therefore, you say, “It is clear the government hasn’t acted radically enough.” You may be right, but I’m not sure it is clear. More radicalism is a fairly hollow cry if you don’t offer specifics. I do think there should be similar relief for renters that there is for people with mortgages; I’m not sure that’s particularly radical, it just seems to be a glaring omission.
I don’t think in general that governments are capable of putting everything right if only they have sufficient political will / radical nerve / clarity of purpose / whatever it is. I think it is better to judge governments on the effects of the policies they implement, considering any opportunity costs, and to argue for polices that we expect to do better, and I struggle to see why whether that policy is radical or not really matters.
Big is better! Always factor in economies of scale! Or reject conventional wisdom.
It turns out that the schools most able to open post lockdown will be small ones — maybe with 25 children in a classroom — but not having 1,000 children on the playing fields at staggered intervals, or queuing for the buses. Small hospitals and clinics will be the most effective ways of treating people who, irrationally or not, have not visited big hospitals.
It should have been evident from delinquent behaviour statistics that big schools have never worked. ‘Public schools’ spotted it — pupils are assigned to a ‘house’ — to break the school down into comprehensible numbers and human identities. Smaller schools, please. And get rid of the creepy school manager role, ‘head teacher’ of hundreds of teachers in different schools. Maybe we should ask how smaller secondary schools could deliver a core curriculum for 14-18 years education, with specialist input.
Everything that Sweden has done to not-lockdown is contrary to WHO advice. We should study whether it is about a different health care style, rather than statistics. I hope it works for Sweden but they are taking risks.
Let’s start breaking down everything which is big or complex — and when we can’t, let’s understand relationships and dependencies. ‘Simpliciate and add lightness’, to quote a racing car designer.
Tom, you say, “The “homes for heroes” scheme had rewarded soldiers’ service in the First World War with proper housing, and it was felt a similar repayment for sacrifices in this conflict was due”. Unfortunately it didn’t.
It was another Lloyd George great phrase which disappeared when the smokescreen cleared.
The task went to a Liberal, Christopher Addison, as the new Health Minister. When the Tories in the LLG Coalition objected to the financial cost, LLG capitulated and moved Addison. Addison subsequently resigned, joined Labour, and helped John Wheatley with his Housing Act in one of the few successes of the first Labour Government.
Given the success of the German health system to save corona virus lives, compared to the NHS, then a bold policy would be to adopt the German private health insurance system.
David Evershed makes a valid point “Given the success of the German health system to save corona virus lives, compared to the NHS, then a bold policy would be to adopt the German private health insurance system.”
We keep touting the NHS as the best health care system in the world when clearly based on International standards across Europe it is not. The system depends heavily on a core of dedicated health professionals continually being asked to go above and beyond to maintain some semblance of acceptable provision with cancer care still lagging most other developed nations.
This pandemic above all has laid bare the vulnerability of the NHS to any surge in demand (someting that occurs every year in flu season) and the inability to maintain an acceptable level of health care and testing for the elderly in care homes.
As David Evershed comments, how the NHS and adult social care is funded to ensure it is fit for purpose going forward is perhaps one of those bold policy areas that needs some serious rethinking.
Barney Reynolds, a partner at Shearman and Sterling LLB, warned a specific, cast-iron pledge agreed between the two parties to use ‘best endeavours’ meant Michel Barnier and his fellow EU negotiators had no excuse not to continue to work towards a deal by December 31 – suggesting failure to do so would permit the UK to “walk away”. Today’s European Council meeting in Brussels is likely to be a tense affair, with leaders of the EU27 due to discuss a 500billion euro package of measures aimed at mitigating the disease’s impact.
https://worldabcnews.com/brexit-news-michel-barniers-promise-means-eu-cant-use-coronavirus-to-delay-brexit-world-news/
Private health care insurance ? A licence to print money for those already with loads of money, and/or former Lib Dem Cabinet Ministers looking to earn a few bob in their enforced retirement. No thank you.
Funny how those with loads of money, e.g. Branson (and Trump), and preach how wonderful free market neo-liberalism is, coming running to the state when they get into trouble. We’ve already had that with the East Coast main line and now expect it with an offshore airline – and some Scottish golf resorts owned by President Disinfectant.
In El Presidente’s case, it’s hard to swallow.,
I think there is quite a bit of muddled thinking in this article. The first is the use of the word radical to describe what the Conservatives have done. I would never describe what they have done as radical – in fact over the years it is quite typical for Tories to throw huge amounts of public money at their supporters whenever there is an economic problem.
Whether it was the ‘Barber Boom’ in the early 1970s, PFIs in the 1990s or ‘Bailing out the Bankers’ in the early 2010s, their approach is never radical as implying change to improve things, but instead was prototypical in supporting Conservative supporters. In each case the boom was followed by a period of retrenchment where the deficit was reduced by cutting public services and benefits for the low paid.
Equally, do not forget that the NHS was established not solely by a public spirited set of doctors supporting a new vision at the end of the war, but the drive of people like Aneurin Bevan the Labour government’s Health Minister and the one man most responsible for driving the creation of the NHS forward. That and lots of hard work. Remember though he did it by “Stuffing the doctors’ mouths with gold” as he put it at least once. That enabled the change to be made and quite quickly substantial progress was made.
If I was asked who was the most successful radical over the last 50 years in the UK , I would simply say Margaret Thatcher. She totally changed the country in the 1980s – in some ways for the better, in many for the worse. But no one can deny that she identified herself with a change in the public mood and used it and the good fortune she had to radically change Britain.
Radical thought is easy, but achieving radical action is much more difficult and will not succeed unless it is based on the realities facing the public at that time. Changing that reality is the difficult part – Margaret Thatcher and the Conservatives managed it, but ultimately Tony Blair didn’t..
However just repeating old nostrums like radical change is needed and we need bold policies won’t even get us as far as Tony Blair unless we once again develop a mechanism to engage with the people of Britain and the realities they face.
That is what we need to revive.
Tom Badham | Sat 25th April 2020 – 12:46 pm
Phil Beesley 25th Apr ’20 – 1:53pm “Big is better!!!”
Was the USSR better governed than Luxembourg?
Shirley Williams, winner of the Crosby by-election, and David Marquand’s preference for leader, wanted us to read “Small is beautiful, economics as if humans mattered” which I am now doing.
The issue of funding a modern healthcare and adult social care system is here now and can no longer be fudged.
The German model consistently achieves better outcomes across the population and is worth looking at https://www.germanyhis.com/
“The German public health care system is based on the principle of solidarity. All people insured by a public health insurer receive the same medical care regardless of their financial status. This is achieved through an income-based common fund where everyone contributes to.”
The health care system in Germany is based on four basic principles:
Compulsory insurance: Everyone must have statutory health insurance provided that their gross earnings are under a fixed limit. Anyone who earns more than that can choose to have private insurance.
Funding through insurance premiums: Health care is financed mostly from the premiums paid by insured employees and their employers. Tax revenue surpluses also contribute. State-funded health care systems like those in Great Britain draw on tax revenue and are subject to the vagaries of which government is in power at any point in time. In market-oriented systems such as that in the United States, many people have to carry the costs of treatment and loss of earnings due to illness themselves or have to get private health insurance.
Principle of solidarity: In the German health care system, statutory health insurance members jointly carry the individual risks of the costs of medical care in the event of illness. Everyone covered by statutory insurance has an equal right to medical care and continued payment of wages when ill – regardless of their income and premium level. The premiums are based on income. This means that the rich can help the poor, and the healthy can help the ill. However, these premiums are only calculated based on a percentage scale up to a certain income level. Anyone earning more than this amount pays the same maximum premium.
Principle of self-governance: While the German state sets the conditions for medical care, the further organization and financing of individual medical services is the responsibility of the self-governing bodies within the health care system. These are made up of members representing doctors and dentists, psychotherapists, hospitals, insurers and the insured people. The Federal Joint Committee is the highest entity of self-governance within the statutory health insurance system.
This is in essence a form of the hypothecated tax/national insurance that Norman Lamb and Vince Cable were calling for https://www.libdemvoice.org/time-to-reform-nhs-funding-vince-cable-56552.html. This was based on a report compiled for the Liberal Democrats by 10 health & social care specialists, including former chief executives of NHS England, the Royal College of Nursing and the Patients Association.
The German model consistently achieves better outcomes across the population and is worth looking at
You’ve overlooked one key factor. The German system is 32% more expensive according to the latest figures in this link. So, before we go changing anything we need to consider that maybe we could get an even better result if we spent the extra and just kept the same system?
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
@Joe Bourke
“Health care is financed mostly from the premiums paid by insured employees and their employers. ”
So what happens to that part of the financing of the healthcare system in Germany when someone loses their job? That seems to be a major problem (among many problems) with the USA ‘system’. People losing their jobs there during the present crisis are losing their health insurance cover.
@Peter Martin
“The German system is 32% more expensive…..”
But we seem in the UK to be paying for a sickness system rather than a healthcare system. The main reason Brits ever make use of the NHS when not already sick or injured appears to be pregnancy and childbirth.
This is recent data for UK health spending
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29
– In 2017, the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD (£2,913 per person).
– However, of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
– As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
– The UK’s publicly funded NHS-based health system contributes to the UK having one of the highest shares of publicly funded healthcare (79%) in the OECD.
– In 2017, the UK spent the equivalent of £560 per person on health-related long-term care, which was less than most other northern or western European countries, but a similar amount to France (£569) and Canada (£556).
Healthcare in Germany is Universal. There is 100% coverage including unemployed. Most people have public health insurance, but around 10% have private. The average cost of insurance is 7.5% for each for employers and employees. 15% for the self-employed, While the healthcare system is run by the German state, it is administered by independent non-profits. This is what separates the German (and other European systems) from the vagaries of government tax policy.
No we don’t need the German private health insurance system (that’s Mr Farage’s policy) or marketization of the NHS. OBs will always attack an institution which succeeds against the odds as it doesn’t fit into their free markets agenda. The Corona virus epidemic is proving how resilient and robust the NHS really is as a public service the envy of the world.
If the NHS was the envy of the world, then why do the majority of developed countries – which rank much higher in healthcare outcomes – use a different model?
France blends a patient centric and choice-based schematic of private sector involvement alongside state coverage and provision. It manages to combine great healthcare outcomes with healthcare for all – which only the state can guarantee. Indeed, one of the most comprehensive comparative studies of world healthcare systems undertaken, The World Health Organization’s 2000 report, ranked the French healthcare system the best in the world.
The French system is universal, in so far as it provides healthcare for all. The use of government in its delivery is considerable, but not excessive (40% of French hospital beds are provided by charities or for-profit companies.) But there is perhaps one key difference, which allows the French system to be so effective: employer provided insurance. Although the government will cover anyone who doesn’t have access to employer provided insurance – providing a minimum of healthcare access – many have extra insurance on top of their basic cover. So, you have a government set baseline, with options for individuals to supplement their cover with private alternatives.
What is key is that the patient is the focus and can choose hers, or his, health providers.
Belgium, Austria and Germany all have similar healthcare provision, mixing a minimum baseline with private options for more cover. Even in Sweden, a bastion of social democracy, where healthcare is provided most like the NHS, a GP visit costs around £15.
We are told the UK healthcare system is the envy of the world In the UK. Unfortunately, that just does not match with the facts. All the empirical evidence points to numerous better styles of healthcare provision around the world and almost all provide near-universal coverage anyway. Putting evidence of what is known to work before ideology is the basis of good policymaking.
@ JoeB,
You ask:
“why do the majority of developed countries……… use a different model?”
Clearly, the concept of a wholly Nationalised health system doesn’t fit well with the prevalent right wing ideology present in most countries – not just the UK. That’s the simple answer and the only sensible explanation of why the Americans have the system they do.
Whatever model is adopted, it doesn’t make any sense to continually be changing it without good reason. The changes we’ve seen, such as, for example, the creation of an internal market, have not been motivated by a desire to improve patient care.
https://www.bbc.co.uk/news/health-31145600
There is no evidence that more privatisation, which is essentially what you are arguing for, leads to “better outcomes”. If there was, we may as well just copy the Americans.
Peter Martin,
“There is no evidence that more privatisation, which is essentially what you are arguing for, leads to better outcomes. There actually is abundant evidence over an extended period of decades that the model adopted by the European social democracies that you refer to as “the prevalent right wing ideology present in most countries” does indeed produce better outcomes.
The UK has chronically lagged behind its European, and American, and Australian, and East Asian counterparts, in its cancer, and other major disease, survival rates, for years. In fact, for decades. A 2017 study led by the Swedish Institute for Health Economics found that between 2000 and 2007 the UK had a lower five-year adult survival rate for 9 out 10 types of Cancer than the European Average – the UK being above average on Skin Cancer.
Another study, in 2015, by the London School of Hygiene and Tropical Medicine, found the same. In the period from 1995 to 2012, comparisons between the UK and 5 other countries – Australia, Canada, Denmark, Norway and Sweden – found UK five year cancer survival rates to be nominally between five per cent and 12 per cent lower, depending on the type of cancer.
This is huge when you consider percentage survival rates for Cancer’s are often, of course, low anyway. If a survival rate for a certain type of cancer is around 30 per cent in one country and 20 per cent in another – which is approximately the difference between the UK and the other countries, for certain cancers, in this particular study – then care in the UK is 33 per cent less effective. Indeed, this is case for stomach cancer, when you compare the UK to Australia.
This simply reinforces the point that it ideology, centraliation of control and under-resourcing that prevents the NHS from achieving a comparable performance to that of other developed countries. It is cerainly not the dedication or competence of the medical practioners that deliver the services. It is the unwieldy monolithic sysyem itself that prevents progress. The problems with British healthcare provision is principally organizational, not monetary. Bourne out by the fact that health outcomes have consistently lagged behind other comparable countries, even in periods of ‘proper’ funding.
Privatisation v more public spending is now a moot point. We’ve turned the country into an open prison, destroyed the economy and normal social interactions.
Arguing about how to fund the resultant collapse is like a bald man debating whether or not he should use hair spray or hair gel on his gleaming pate.
We certainly need a more inclusive, collaborating politics and society. We need to devise a system where all of talent can contribute regardless of political affiliation. PR would aid this and perhaps in the aftermath of this crisis wisdom will prevail and structures such as it and more direct and devolved democracy can be at least be given a nudge.